Naso-orbito-ethmoid fracture

Markowitz–Manson 1991CTTrauma

Figure · click to enlarge

Markowitz–Manson types I–III. Image: American Academy of Ophthalmology, aao.org

Classified by the central fragment: the piece of medial orbital rim that carries the medial canthal tendon (MCT). Whether that fragment is intact, comminuted or avulsed decides the repair.

Type	Central fragment	MCT
I	Single large fragment, minimal comminution	Attached to the large fragment
II	Comminuted, but the tendon-bearing piece is still sizeable	Attached to a fragment large enough to fix
III	Severe comminution of the central fragment	Avulsed or disrupted; needs canthopexy

Report

Central fragment size, comminution and displacement on axial and coronal images.
Lacrimal fossa and nasolacrimal duct involvement.
Frontal sinus outflow tract and posterior table; cribriform plate and fovea ethmoidalis (CSF leak risk).
Clinically, telecanthus (widened intercanthal distance) suggests MCT displacement.

Sources

Markowitz BL, Manson PN, Sargent L, et al. Management of the medial canthal tendon in nasoethmoid orbital fractures: the importance of the central fragment in classification and treatment. Plast Reconstr Surg. 1991;87:843–853.PubMed ↗

Radessential summarizes published classification systems for practicing radiologists. Summaries are condensed; confirm details against the cited source before relying on them for patient care.